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Advanced 3 CHAIN OF CUSTODY RECORD <br /> 1 . <br /> GeoEnvironmental, Inc. Date ' Z Page �f, <br /> 4005 North Wilson Way-Stockton,California 95205-(209)467 1006-Fax(209)467-1118 <br /> T� 1 h Project Manager <br /> Client hq 1. <br /> `f' I Tests Required <br /> rJ �/GC till�`r <br /> 4-- Phone Number L <br /> Samplers (Signatur ) Invoice <br />� Project Name j� �� AGE <br /> Client ❑ <br /> Sample Type <br /> Sample Location No of <br /> Date Time Water Solid Notes <br /> Number Description Comp crab Air Conts <br /> f6 L-fil /% Al <br /> Date/Time <br /> Re in y ( ignatur ecewe y (Signature) -15 -qa ? ,� <br /> Relinquished by (Signature) Received by (Signature) DatelTime <br /> i <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Receiv for Laboralor by Date/Time <br /> 6-tC oGo <br /> Method of Shipment Lab tatory Nam7as <br /> Special Instructions t Torize <br /> the performance of the above indicated work <br /> 1 <br />